多壁碳纳米管与甘草苷和异甘草苷的选择性吸附作用

碳纳米管作为一种特殊的纳米材料,具有中空结构,高强度韧性及良好的化学和热力学稳定性。对人体毒性小,有良好的生物相容性,一直被期望作为药物传送系统的运输载体[1~4]。在碳纳米管与生物体系相互作用研究中发现碳纳米管是一种高效地向细胞内输送药物的载体。沈海军[5]利用MM     

Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis

This systematic review assessed study-level determinants of non-covering (inappropriate) empirical antibiotic treatment (IEAT), focusing on the influence of study years and the prevalence of multidrug-resistant organisms (MDROs) in the study. Prospective and retrospective observational studies reporting on the association between IEAT and mortality in adult patients with microbiologically documented infections published between 2008–2016 were included. A meta-analysis of IEAT rates was conducted using a random-effects model. Subgroup analyses and mixed-effect single-covariate meta-regression were conducted to identify the association between clinical and methodological study-level covariates and IEAT rates. Heterogeneity was assessed using the I² measure of inconsistency. Multi-covariate meta-regression was conducted including variables with a P-value of <0.1 on single-covariate analysis. A total of 191 studies were included assessing 73 595 patients, most commonly with bacteraemia. The pooled IEAT event rate was 32% [95% confidence interval (CI) 30–35%], with large heterogeneity (I²?=?97.7%). On multi-covariate analyses, the prevalence of any MDRO [odds ratio (OR) per 10% increase in prevalence?=?1.11, 95% CI 1.07–1.15], Acinetobacter spp. specifically (OR?=?1.99, 95% CI 1.22–3.25) and advancing study years were associated with IEAT rates (OR?=?1.03, 95% CI 1.00–1.06 per year). MDRO rates were independently associated with mortality rates in the studies, adjusting to the rate of IEAT. The prevalence of MDROs, mainly multidrug-resistant Gram-negative bacteria, is significantly associated with the probability of prescribing IEAT and mortality rates in recent studies. We show how antibiotic resistance impacts patient management and outcomes.     

Acupuncture treatment for opiate addiction: a systematic review

A review of the efficacy of acupuncture as treatment for opiate addiction, covering 33 years of reported literature in western scientific journals, was systematically undertaken. Some abstracts from Chinese language journals were also briefly reviewed.

Supportive evidence often came from noncontrolled nonblinded methodologies. When well-designed clinical trials (randomized, controlled, single-blind methodologies) were used, there was no significant evidence for acupuncture being a more effective treatment than controls. Some of the current supportive evidence for efficacy came from Chinese journals that have not been translated into English yet.     

Potential of coffee husk biomass waste for the adsorption of Pb(II) ion from aqueous solutions

The uptake of Pb(II) from the aqueous solution by Coffee Husk Biomass Waste (CHBW) as a green low cost solid phase adsorbent was critically studied. The chemical composition and the surface morphology of the CHBW were determined and fully characterized by FESEM-EDX. In batch mode, the effect of various analytical parameters e.g. adsorbent dose, contact time and analyte concentration on lead(II) ions retention by the biomass CHBW was performed. The adsorption equilibrium of Pb(II) ions was achieved after 60 min with very high percentage 98%, and an adsorption capacity of 19.02 mg/g lead towards the adsorbent was determined. Sorption kinetics data was fitted well with pseudo-second-order model with good correlation coefficient (R² = 1) and (q_e,cal) 19.23 mg/g, (eq_e,exp) 19.07 mg/g. The sorption isotherm fitted better with the Freundlich model (R² is close to the unity). The Langmuir gives maximum adsorption capacity (q_max) of Pb(II) was 37.04 mg/g. These results indicated that, the coffee husk is an efficient, sustainable, and low-cost adsorbent for Pb(II) uptake from wastewater.     

Current pharmacotherapy for gambling disorder: a systematic review

ABSTRACT

Introduction: Gambling disorder is classified as an addictive disorder and is associated with significant distress and impairment in personal, social, occupational or other important areas of functioning. Although no pharmacotherapy has a formal indication for gambling disorder, data suggest potential benefits of specific medications.

Area covered: This systematic review evaluated findings from 19 randomized controlled trials testing pharmacotherapies for the treatment of gambling disorder.

Expert opinion: Few randomized controlled trials have studied pharmacotherapies for gambling disorder. Though results are limited, opioid antagonists like naltrexone showed promise in the pharmacological treatment of gambling disorder. Pharmacotherapy combined with psychotherapy treatments for gambling disorder may provide better rates of patient retention in comparison to pharmacology-only treatments, though further research is needed in this area. Future studies should address gaps relating to considerations of racial, ethnic, gender and other individual differences in clinical studies. Because gambling disorder often co-occurs with other psychiatric disorders, additional research is needed to test treatments for dually diagnosed patients.     

Aqueous nitrate ion adsorption/desorption by olive solid waste-based carbon activated using ZnCl2

ZnCl₂ activated carbon (ZnCl₂-AC, with specific surface area ~1480 m²/g) effectively adsorbs nitrate from water with uptake capacity (~5.5 mg/g) four-fold that for other commercial activated carbons (CACs). Kinetics show a small activation energy value (~7 kJ/mol) consistent with a diffusion-controlled process. This is further confirmed by intra-particle diffusion study. Negative thermodynamic parameters (ΔH° ?13.859 kJ/mol, ΔS° ?43.8 J/mol K, and ΔG° ?0.808 kJ/mol) indicate spontaneous nitrate adsorption. The high specific surface area rationalizes the high uptake capacity for the ZnCl₂-AC. A Langmuir type adsorption, is observed. ZnCl₂-AC effectively adsorbs the nitrate from water, even at high concentrations, and brings the concentration to allowed maximum values. Despite these advantages, the ZnCl₂-AC exhibits low desorption (~20%) of pre-adsorbed nitrate ions into concentrate solutions. Up to ~40% desorption is observed by grinding the pre-saturated ZnCl₂-AC. Developing other methods to completely recover the adsorbed nitrate and the adsorbent for multiple use is needed.     

The effectiveness of diversion programmes for offenders using Class A drugs: a systematic review and meta-analysis

Aims: To review existing evidence on effectiveness of community-based diversion programmes for Class A drug-using offenders.

Methods: 31 databases were searched for studies published 1985–2012 (update search 2012–2016) involving community-based Criminal Justice System diversion of Class A drug users via voluntary or court-mandated treatment.

Findings: 16 studies were initially included (US, 10; UK, 4; Canada, 1; Australia, 1). There was evidence for a small impact of diversion to treatment on drug use reduction (primary Class A drug use: OR 1.68, CI 1.12–2.53; other drug use: OR 2.60, 1.70–3.98). Class A drug users were less likely to complete treatment (OR 0.90, 0.87–0.94) than users of other drugs. There was uncertainty surrounding results for offending, which were not pooled due to lack of outcome measure comparability and heterogeneity. Individual studies pointed to a minor effect of diversion on offending. Findings remained unchanged following an update review (evidence up to March 2016: US, 3; Australia, 1).

Conclusions: Treatment accessed via community-based diversion is effective at reducing drug use in Class A drug-using offenders. Evidence of a reduction in offending amongst this group as a result of diversion is uncertain. Poor methodological quality and data largely limited to US methamphetamine users limits available evidence.     

Drug treatment aftercare in the criminal justice system: a systematic review

Drug treatment aftercare is frequently cited as necessary for individuals served within the criminal justice system. The purposes of this article are to review how much is actually known about aftercare and to highlight issues in studying the role of aftercare. We begin with a review of the literature, looking at how aftercare is defined within the criminal justice system outcome literature and the findings on aftercare for offenders who received initial treatment from in-prison substance use treatment programs. We continue with a discussion of how substance use treatment provided within the federal system, drug use patterns, and responses to drug use create methodological difficulties in adequately assessing the effectiveness of aftercare services. Taking into account both the previous research on aftercare and the issues encountered in attempting to evaluate the federal aftercare services, we concluded that the claim of certainty about aftercare effectiveness is not well substantiated and that the precise nature of aftercare services needed is not well understood. We conclude with a discussion of the methodological and substantive issues that need to be addressed in future research. Issues identified include the need to address self-selection bias and to disentangle offender behavior from the effects of criminal justice system policies. Research is also needed to identify the most effective type and intensity of aftercare.     

Shark cartilage for cancer patients: a mini systematic review

The objective of this systematic review was to assess the effectiveness of shark cartilage as a treatment option for cancer patients. Six databases were searched from their inception to August 2010. Only RCTs testing shark cartilage against any control intervention in humans with any type of cancer were considered. The selection of studies, data extraction and validation were performed by one reviewer. For safety and toxicity studies, uncontrolled trials and case studies were excluded. Two RCTs met the inclusion criteria. The methodological quality of studies was high. None of the RCTs suggested that shark cartilage plus conventional treatment lead to a significant reduction in tumour size or improvements in overall survival when compared to placebo and conventional treatment. Current clinical evidence does not support the efficacy of oral shark cartilage in cancer treatment.     

Differential heat of adsorption of water vapor on silicified microcrystalline cellulose (SMCC): An investigation using isothermal microcalorimetry

A novel dual-shaft configuration in isothermal microcalorimetry was developed to study the interaction of water vapor with pharmaceutical excipients. An instrument performance test is suggested to validate the experimental data. Reliable experimental results can be collected using a single perfusion shaft; however, there was limitation of the dual-shaft configuration, which resulted deviation in the experimental results. A periodic performance test is recommended. Silicified microcrystalline cellulose (SMCC) was used as a model system to study the interaction using the dual-shaft method. Enthalpy of water vapor adsorption on SMCC was determined and compared to literature data. The data collected using the dual-shaft configuration did not reflect the actual physical system. The deviation was most likely due to the lack of flow control caused by viscous resistance. The enthalpy of adsorption was then calculated using isothermal microcalorimetry coupled with a dynamic vapor sorption apparatus. The results, ?55 kJ/mol at low relative humidity (RH) to ?22 kJ/mol at high RH, were consistent with the physical phenomenon of water vapor adsorption. Enthalpy of adsorption showed surface heterogeneity of SMCC and suggested multilayer condensation of water at approximately 60% RH. However, at high RH, the results showed the moisture-excipient interaction can be more complex than the proposed mechanism.     

Individual and competitive adsorption of ibuprofen and caffeine from primary sewage effluent by yeast-based activated carbon and magnetic carbon nanocomposite

Pharmaceuticals enter water bodies mainly through urban effluents harmful to the biota, inducing microbial resistance, and impacting hydric security. Activated carbon has been used for effluent treatment and associated with ferromagnetic nanoparticles can facilitate the separation of this adsorbent from an aqueous medium and improve the adsorption capacity. A yeast-based carbon (YC) prepared from the residue of the ethanol industry and a magnetic composite prepared from YC (NP-YC) were used to remove ibuprofen (IBU) and caffeine (CAF) from deionized water and primary sewage effluent (PE). A minimum of 51 and 90 mg/g of IBU and CAF were removed by NP-YC, respectively, whereas YC removed a minimum of 107 and 106 mg/g for such contaminants. The removal of both contaminants was favored for competitive studies using NP-YC as adsorbent (removals >70% for deionized water, and >60% and >75% for IBU and CAF, respectively, for PE). The values of q_max obtained for YC in the competitive assays were about the sum of both q_max for the individual experiments suggesting that each molecule adsorbs in a different site. Successive adsorption cycles using the same mass of adsorbent removed higher amounts of IBU and CAF by exposing the adsorbents to new volumes of a solution containing equal or increasing concentrations of contaminants than those exposed to a single high concentration solution. This behavior is probably due to the driving force effect. It suggests that the reuse of synthesized adsorbents was possible without previous desorption, increasing the usability of the synthesized adsorbents.     

Retention in medication-assisted treatment for opiate dependence: A systematic review

Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010–2014) found wide variability in retention rates (i.e., 19%–94% at 3-month, 46%–92% at 4-month, 3%–88% at 6-month, and 37%–91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.     

Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity

Introduction: Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes.

Areas covered: A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared.

Expert opinion: Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.     

Single nucleotide polymorphisms in treatment of polycystic ovary syndrome: a systematic review

Abstract

As 15–20% of reproductive aged females are suffering from polycystic ovary syndrome (PCOS), a large number of pharmacological preparations are frequently available in the market for the treatment of PCOS; however, they seem to be ineffective and cause undesirable side effects. This has emphasized the need to optimize dosage regimens for individualized treatment. The objective of this systematic review is to review single nucleotide polymorphisms (SNPs) associated with drugs used for the treatment of PCOS to understand pharmacogenetics variability of patients to drug response there by helping clinicians in designing tailored treatments and possibly reducing adverse drug reactions. A comprehensive electronic literature search was conducted to highlight some clinically relevant SNPs that act to influence PCOS and associated co-morbidities. A total of 16 studies were included in this review. These genetic variations can be used as a potential target for pharmacotherapy and pharmacogenetic clinical trials for better diagnosis, management, and treatment planning.     

普瑞巴林治疗广泛性焦虑障碍的疗效与安全性的系统评价

目的系统评价普瑞巴林治疗广泛性焦虑障碍(GAD)的临床疗效和安全性。方法电子检索CENTRAL、Pubmed、EMbase和中国生物文献数据库文献(CBM),全面收集普瑞巴林治疗GAD的随机对照试验(RCTs),采用Cochrane系统评价方法评价纳入RCTs的方法学质量后,采用RevMan 5.1.4软件对提取的数据进行分析。结果纳入7个RCTs,共2 410例患者。与安慰剂相比,普瑞巴林150 mg·d~(-1)治疗GAD有效率无统计学差异[RR=1.32,95%CI(0.98,1.79),P=0.07],普瑞巴林固定剂量200～450 mg·d~(-1)[RR=1.60,95%CI(1.34,1.93),P<0.01]、600 mg·d~(-1)[RR=1.42,95%CI(1.18,1.70),P=0.000 2]以及可变剂量组[RR=1.25,95%CI(1.06,1.49),P=0.01]有效率差异均有统计学意义。与安慰剂组相比,普瑞巴林固定剂量组150～450 mg·d~(-1)以及可变剂量组因不良反应退出试验人数差异无统计学意义(分别为P=0.26,P=0.12);而普瑞巴林600 mg·d~(-1)组因不良反应退出试验人数差异有统计学意义[RR=1.76,95%CI(1.16,2.68),P=0.008]。结论普瑞巴林200～450 mg·d~(-1)治疗GAD有效且安全性好。     

Combatting resistant enterococcal infections: a pharmacotherapy review

Introduction: The role of enterococci in infectious diseases has evolved from a gut and urinary commensal to a major pathogen of concern. Few options exist for resistant enterococci, and appropriate use of the available agents is crucial.

Areas covered: Herein, the authors discuss antibiotics with clinically useful activity against Enterococcus faecalis and E. faecium. The article specifically discusses: antibiotics active against enterococci and their mechanism of resistance, pharmacokinetic and pharmacodynamic principles, in vitro combinations, and clinical studies which focus on urinary tract, intra-abdominal, central nervous system, and bloodstream infections due to enterococci.

Expert opinion: Aminopenicillins are preferred over all other agents when enterococci are susceptible and patients can tolerate them. Daptomycin and linezolid have demonstrated clinical efficacy against vancomycin-resistant enterococci (VRE). Synergistic combinations are often warranted in complex infections of high inoculum and biofilms while monotherapies are generally appropriate for uncomplicated infections. Although active against resistant enterococci, the pharmacokinetics, efficacy and safety of tigecycline and quinupristin/dalfopristin can problematical for severe infections. For cystitis, amoxicillin, nitrofurantoin, or fosfomycin are ideal. Recently, approved agents such as tedizolid and oritavancin have good in vitro activity against VRE but clinical studies against other resistant enterococci are lacking.     

Management strategies for acute infective conjunctivitis in primary care: a systematic review

A systematic review of the literature on all aspects of the management of acute infective conjunctivitis is undertaken. Acute infective conjunctivitis is a common presentation in primary healthcare. It is usually a mild condition and serious complications are rare. Clinical signs are a poor discriminator of bacterial and viral causes. Studies of treatment show that there is a high rate of clinical cure without any treatment (65% within 2 – 5 days). Treatment with topical antibiotics improves the rate of clinical recovery and this is more marked in the first 2 – 5 days after presentation (number needed to treat [NNT] = 6), but less by 6 – 10 days (NNT = 13). Studies comparing treatment with different antibiotics do not demonstrate that any one antibiotic is superior; the choice of antibiotic should be based on consideration of cost and bacterial resistance. The present practice of prescribing antibiotics to most cases is not necessary.     

Fabrication of porous polyethyleneimine-functionalized chitosan/Span 80 microspheres for adsorption of diclofenac sodium from aqueous solutions

Porous surface-modified microspheres can have widespread applications in the removal of wastewater pollutants. In this study, using a nonionic surfactant (Span80) as the pore-forming agent and Zr⁴⁺ as the cross-linking agent, polyethyleneimine (PEI)-modified porous CYCTS/Span80 microspheres ((CYCTS/Span80)-@-PEI) were successfully prepared for the adsorptive removal of diclofenac sodium (DS) from wastewater. The adsorbent was characterized using Fourier-transform infrared spectroscopy, energy-dispersive X-ray spectrometry, scanning electron microscopy, and X-ray diffractometry. The activity of the porous (CYCTS/Span80)-@-PEI microspheres as adsorbents of DS was investigated by varying the experimental parameters (i.e., adsorbent dosage, adsorbent ratio, pH, contact time, temperature, and pollutant concentration). A possible adsorption mechanism was also discussed. The experimental results showed that the adsorption process followed a pseudo-second order kinetic model and the Langmuir adsorption isotherm model, in addition to the Freundlich isotherm model, indicating that the porous structure allowed multi-layer adsorption. Adsorption equilibrium was reached after 240 min at pH 5 and 303 K, yielding a maximum adsorption capacity of 572.67 mg/g. After five adsorption cycles, the removal rate of DS remained >80%, and the recovery rate was high. Therefore, we concluded that the porous (CYCTS/Span80)-@-PEI microspheres are efficient and inexpensive candidates for the removal of DS from wastewater.